Help Your Kids Be Their Best Selves with Dr. Ellen Rome

Podcast Transcript

Nada Youssef:   Hi. Thank you for joining us. I'm your host, Nada Youssef. With school being right around the corner, many parents are getting ready for another busy school year. So, besides thinking of your school supplies and uniforms, we need to bring up the real issues that matter the most, and that's our kid's mental well being. Today we will be focusing on how to manage or monitor your children's anxiety or depression as we make that transition from summer break to school year. So, leave any questions you may have in the comment section below.

Nada Youssef:   And today, we have with us, the head of the Cleveland Clinic Center for Adolescent Medicine and Professor of Pediatrics at Cleveland Clinic's Learner College of Medicine, Dr. Rome. Thank you so much for being here.

Dr. Ellen Rome: Thank you for having me.

Nada Youssef: If you want to just take a few moments to introduce yourself to our viewers.

Dr. Ellen Rome: So, I'm Dr. Rome. I'm a pediatrician and head of adolescent medicine and my specialty is teenage health, but that also extends all the way from zero through college age and we're all about positive youth development and helping you raise kids to be their best selves.

Nada Youssef: Great. Thank you so much. And, before we get started, please remember, this is for informational purposes only and it's not intended to replace your own physician's advice. So, let's start by just asking what causes anxiety when we go back to school? What is the biggest reason?

Dr. Ellen Rome: So, back to school jitters may be exactly that. For some kids, it's gonna be anticipation of where am I gonna be? What's the class gonna be like? What's the teacher gonna be like? For other kids, it may be anticipation of a school yard bully from the year before or from the neighborhood. Kids can be worrying about new friends, new situations, and then logistics. Am I gonna get lost? How do I find my way from place to place? Are my classes gonna be a lot harder?

Nada Youssef: Yeah.

Dr. Ellen Rome: As your daughter told you.

Nada Youssef: Yes, yeah. My daughter's going to second grade and she's worried that school's gonna be so much harder than first grade and that's real issues there.

Dr. Ellen Rome: For a second grader, that can be a big deal.

Nada Youssef: Yeah.

Dr. Ellen Rome: I'm not gonna be able to handle the change.

Nada Youssef: Now, with all the worries that parents may have, we want to talk about why it is very crucial to send your kids to school, besides to learn. There are other things that they're learning in school. Let's talk about those.

Dr. Ellen Rome: So, with each day of school, the child's learning and developing and practicing social skills. How do I greet an adult, a teacher? How do I play with classmates and navigate playground? And it's a chance for skills building and for success in these day to day activities. You want your child building their strengths, able to successfully overcome a fear, and come out on the other side having succeeded. And, you can also build relationships between kids, build relationships with adults, and also still be able to miss their lovable, loved last year teacher.

Nada Youssef: Yeah.

Dr. Ellen Rome: These are all okay developmental milestones for each kid.

Nada Youssef: Yeah. Another thing I'm actually, I look forward to, is screen time goes way less because in summertime, that's all they do is watch a lot of TV, a lot of games, and this is a way to interact and learn about your social skills that they don't get a whole lot now, nowadays at least.

Dr. Ellen Rome: For all of you, parents, by the way, on that note of screen time, the American Academy of Pediatrics would love everyone getting no more than two hours of screen time a day. It's fair game to be exponentially less than that and then what they're watching matters.

Nada Youssef: Yeah. Absolutely.

Dr. Ellen Rome: So, if your child is watching scary stuff right before school, they may not be sleeping well.

Nada Youssef: Right.

Dr. Ellen Rome: And, if they're watching ABC, doing interactive ABC stuff before preschool or kindergarten, they may come in feeling confident that they know their numbers or letters or other activities. So, what they watch and how much they watch really matters.

Nada Youssef: I know. I was just reading about that, about AHA recommending one to two hours for kids.

Dr. Ellen Rome: Or less.

Nada Youssef: Or less. One hour for kids under five, but they're saying that the average right now is between eight and eleven hours.

Dr. Ellen Rome: Correct.

Nada Youssef: How do you think it's a way for any parent that's used to giving them an iPad while they're parents would...what's your recommendation on how to get away from that habit?

Dr. Ellen Rome: So, yes. You can...so for instance, for the little, little's, and you need them distracted while you shower or cook dinner, you can say, "See if you can do this puzzle.", or, "Draw me a picture faster than I can shower."

Nada Youssef: That's very good.

Dr. Ellen Rome: "Oh, that was a good one. Let's see another."

Nada Youssef: Yeah.

Dr. Ellen Rome: And you're trying to get each child into, what we call, growth mindset, which is basically that ability to adapt, develop, and work their hardest as opposed to, "Oh, I got that one perfectly. I don't want to do anything more because I might mess it up."

Nada Youssef: Yeah.

Dr. Ellen Rome: So, you want to be able to help kids have a little bit of resiliency as they face new situations and old ones that were challenging.

Nada Youssef: Great. Great. And I found another tip to be helpful, is I found workbooks that has a little bit of math, little bit of English, and that's kind of like school work for them already, but like kind of again just starting them off before going back to school.

Dr. Ellen Rome: And workbooks, you're doing it ideally by hand.

Nada Youssef: Yes. So, it's exactly the...

Dr. Ellen Rome: Also, not screen time.

Nada Youssef: Right. So, let's talk about how to deal with back to school anxiety starting with the health basics, just sleep, food.

Dr. Ellen Rome: So, sleep is big one.

Nada Youssef: Yeah.

Dr. Ellen Rome: And, especially for those of you who have teenagers. They may be on summer schedule where they're going to bed at 2:00 a.m. and then up at the crack of noon and so, now, and ideally, a couple of weeks ago, you'd want to start shifting their sleep wake cycle so that, if they're going to bed a 2:00, all of a sudden they're going to be at midnight, and getting up at 10:00, and then going to bed at 11:00 and getting up at 9:00, and doing that about, with every couple days to every week, so that they can change their circadian rhythms so that, the Monday that school starts, they don't think they've just flown from L.A. to Cleveland as far as their sleep/wake cycle.

Nada Youssef: It's like jet lag.

Dr. Ellen Rome: Correct.

Nada Youssef: Yeah.

Dr. Ellen Rome: So, you're basically helping immunize them against jet lag.

Nada Youssef: Yeah.

Dr. Ellen Rome: So, sleep is important. The average kid needs somewhere between nine, nine and half hours for most kids. Some kids can be functional with less, but most of us, except for those rare lucky few who have more hours in the day, who can survive on less than...

Nada Youssef: Nine hours?

Dr. Ellen Rome: Yes. Or even seven hours in this growing phase. For those that have shorter kids who are fighting sleep, who want to grow, you can say, "You know what? You're growing most when you're asleep. That's part of why we're gonna help you develop these good habits."

Nada Youssef: Yeah.

Dr. Ellen Rome: So, sleep hygiene is incredibly important. On the summer sometimes, people can be more relaxed about also eating out and about. That can mean caffeine in the form of Starbucks or pop, soda if you're from the east or west coast, or God forbid, energy drinks that have very high doses of caffeine.

Nada Youssef: Iced tea.

Dr. Ellen Rome: Well, I'm more worried about teens and Red Bull and one's that are very, very concentrated caffeine dosing. Those kids don't realize that caffeine's a 24 hour drug, so it may be interrupting sleep as well.

Nada Youssef: Right.

Dr. Ellen Rome: Besides sleep habits, really good eating habits matter. So, having a kid be prepared to do a breakfast, a lunch, a dinner with or without a couple of snacks, so that they get in the habit of eating before they head to school, is an important one for energy as well. It doesn't have to be an elaborate English breakfast before school, but having them have something that's gonna get their energy going and be enough to last them for lunch. That also may mean partnering with your kid to figure out what are gonna be snacks and, if you have a kid that has food allergy or something else, that can be a part of back to school anxiety. Am I gonna be able to get my safe snacks? Am I gonna be able to eat or drink when I need in order to be physically healthy as well? And that's where a parent can partner with a kid and with a teacher in the school to make sure that the right set up is happening for that kid.

Nada Youssef: Sure. And maybe even helping mom pack.

Dr. Ellen Rome: Yes.

Nada Youssef: That would get them into just making sure it's a healthy snacks and making sure it's all together.

Dr. Ellen Rome: And, for a kid who's particularly anxious about this, it's fair game to ask school if you can do a dry walk through.

Nada Youssef: Right.

Dr. Ellen Rome: So, get there a day or two or three or the week before, walk through, find the locker, find the classrooms, find where the snacks are kept, find where the bathroom is, figure out how a kid who's really anxious is gonna navigate that day and demystify it.

Nada Youssef: Yeah.

Dr. Ellen Rome: And then partner with the teachers to help make that an optimal success year for that kid.

Nada Youssef: Absolutely. Absolutely. Let's talk a little bit about the psychology part behind it. Encouraging your kids to speak up about their fears and their worries, because a lot of times they don't really tell you much until it's literally time to go, and then the world's falling apart.

Dr. Ellen Rome: So, opening those lines of communication with a child are very, very important, as well as with the caring adults who are gonna be in that kid's life within the school building.

Nada Youssef: Right.

Dr. Ellen Rome: So that may mean helping the kid find a safe place to talk. So, for instance, parents, we often have our personal enslavement devices and so when your kid wants to talk, even if it's an inconvenient time, make that go away and, when it's family dinner, parent, unplug and role model especially if we want our kids to unplug, so helping them figure out that a conversation's a conversation can be really useful. Another great time for that is when you're in the car or in transit some place because you can literally use your vehicle to be a vehicle of communication.

Nada Youssef: Yes.

Dr. Ellen Rome: And especially with tweens and teens, it can...but also with school age, it can be really safe to be talking when mom's driving and not staring at you too much.

Nada Youssef: Right.

Dr. Ellen Rome: To be able to kind of have that casual conversation.

Nada Youssef: Sure.

Dr. Ellen Rome: If you're not the one who's gonna be there for pick up after school, it's worthwhile training whoever is gonna be that caring adult to be able to have a debriefing conversation. "Tell me about the day. What was the best part? What was the worst about it?" And then, also, be able to share that information with you, the parent, so that you know what's going well and what isn't. Dinner time, family dinner, can't say enough good things about that, is another positive time for communication and, if your family's only getting time for one a week, see if you can triple it. If your family is getting five, six, seven nights a week, family dinner, go you. Share that with your friends.

Nada Youssef: Absolutely.

Dr. Ellen Rome: And dinner, it's fair game to say, to talk about what happened to you and how you role modeled handling a stressful moment. So, you can have kind of standard questions. "What was the funniest part of your day? What was the most embarrassing part of your day?" And have you be prepared to role model how do I answer these questions for myself with my kids.

Nada Youssef: Right, right. And the thing, just like where you were saying earlier about the phone as adults, our kids are always reflecting what they see.

Dr. Ellen Rome: Yes.

Nada Youssef: So, if I'm always on my phone, they're probably gonna be like, "Oh. Let me go watch some TV." So, I think it is very, very important to talk to the kids. That's great. Thank you. Now, I want to talk about how to prepare children, hopefully, some people have some weeks ahead before school. I know I do. I know some people are probably starting school already, but how to get on to that school day routine. What kind of things can we as parents do?

Dr. Ellen Rome: So, for those who already have phones, really good cell phone practices. In a perfect world, being about to have the cell phone plugged into the kitchen, not in the bedroom. For those that need it as an alarm, having each kid know that they want to have it face down and on silent, do not disturb, where the alarm can ring, but the screen is not waking them all night.

Nada Youssef: Okay.

Dr. Ellen Rome: For those that need a different kind of alarm, have a good dry run on that and figuring out is this something that wakes your kid and that can also help them prep for starting to move their sleep schedule so that it's compatible with school.

Nada Youssef: Sure.

Dr. Ellen Rome: If, for school, they have to get up at 6:00 to get there, and they've been sleeping until 9:00 or 10:00 all summer, don't wait until that day before, or the morning of, to have that be the first early morning.

Nada Youssef: Yeah.

Dr. Ellen Rome: So, practice the routine. Practice how to put clothes out the night before.

Nada Youssef: Yeah.

Dr. Ellen Rome: How to have all of your homework stuff or paperwork or whatever it is, eraser, whatever you need, already the night before and then also teach and role model and practice what do you do when you're nervous? What do you do when you get the jitters or the butterflies? How do you put on your brave face and manage it?

Nada Youssef: So, I'll ask you. What do you tell your child how to not be nervous? What kind of things do you tell your children?

Dr. Ellen Rome: Well, a little bit of nerves or nervousness can actually be motivating. So, that's how, in the olden days, in the caveman days, we could out run the saber tooth tiger. We could even figure out there was a saber tooth tiger that we needed to out run or out smart.

Nada Youssef: Yeah.

Dr. Ellen Rome: For now, we can help teach them a little bit of nerves, that's pretty okay. When that little bit of nerves gets to be so big that it's hard to handle, that's where you call a life line. You talk to a parent. You talk to the teacher. You can have a conversation with a friend and figure out, how do I break this down so that it becomes an okay thing?

Nada Youssef: Right, right. Great. And on being present, talking just in the now, making sure that everything is out in the open. And then, again, with lunches, just to get them prepared. My kids get very excited when I go get them snacks from the store and we start planning like what kind of things do you want to eat? What kind of snacks do you want? Things like that, so maybe that will also help.

Dr. Ellen Rome: So, including them in the process is a great idea.

Nada Youssef: Yeah. Great. And then, you said coping skill for nervousness and then also, for the little ones, my youngest is four, going into pre-K, big deal, and I was thinking about sending something with her that reminds her of home, that makes her less anxious.

Dr. Ellen Rome: For the little's, it's always fair game to have a transition object that can go with. In a perfect world, you want to make it not so special that if it gets mangled or broken or dirty on the playground that it's not irreparable.

Nada Youssef: Right.

Dr. Ellen Rome: So, for some, it may be a note or a picture in the lunch box with a heart or I love you or something that reminds them you've got their back.

Nada Youssef: Their mom's there. Yeah. Absolutely.

Dr. Ellen Rome: That you're there thinking of them. For others, it may be having a favorite sweatshirt and when you can...

Dr. Ellen Rome: Having a favorite sweatshirt, and when you can, if it's a favorite clothing or thing, buy two so one can be in the wash and the other one can still go to school.

Nada Youssef: That's a good point.

Dr. Ellen Rome: And for others it may be having a favorite story that you can partner with a teacher to see of it can be part of what gets read on those first days of school.

Nada Youssef: Well, let's get a little bit more serious about this. We talk about kids with anxiety and depression. Is the approach different when it comes to them?

Dr. Ellen Rome: Yes. When you have a child who does have significant anxiety or depression, you want to partner with your pediatrician, you want to partner with the parents, and partner with the school, the teachers. Prep the teachers and care team at the school to know here's a kid who's at risk. And for those who get serious panic attacks, it may be worthwhile teaching them, for instance, to breathe a square. You can imagine a square with four sides and you breathe in two sides, and breathe out two sides. And then the sides can go slower and slower.

Dr. Ellen Rome: And there are apps, such as the Breathe app that can do that. But you can't really pull out an app in a classroom. So having them have a mindful strategy and then warning the teacher, if my kid seems like they're tuned out it's fair game to not call them out and make them more anxious, but help them tune in, so you may want to add a meeting with a teacher with a kid and say, "When I see you having a stressful moment, here's some things we can try." For some kids, it may be a gentle touch on the shoulder as the teacher goes by. For another kid it may be sitting them so that they're not near the class bully or other person that they anticipate is a stress. Partnering with a teacher to read that child's cues are very important. It may be worthwhile having a kid know where the school guidance counselor's office is, or the school nurse so that they know if they're having a serious panic moment, there's a safe place to go.

Dr. Ellen Rome: For the child who is depressed or anxious who has access to social media, the more anxious, the more stressed, the more they should disconnect from social media. We have a definite correlation with more social media, lower self-esteem for that vulnerable kid. We know that's one of the places where cyber bullying can happen, but it's not just that. If the kid is depressed, or exceptionally anxious, and everyone is all posting pictures on Snapchat or Instagram about their happy summer experiences or their happy this or happy that, that child may feel worse and forget that nobody posts their unhappy moments. So it can magnify their sense of difference from those other kids.

Nada Youssef: Right. That's a really hard one to control, too. Social media. What can you do besides take away someone's phone?

Dr. Ellen Rome: It's fair game to take away someone's phone.

Nada Youssef: Yeah, absolutely.

Dr. Ellen Rome: And so it's fair game for a kid who's really overly connected to be able to have that phone be placed in the guidance counselor's or the nurse's office or the locker, or somewhere that it gets pulled out to touch base with a parent or with the care team, and then pulled out to arrange the ride at the end of the day, but that minute by minute the kid's not drawn to be checking. So helping the kid learn how to disconnect and be present can be really useful. That's something that can be practiced over the summer also. Have a phone-free week. Or a month. Summer.

Nada Youssef: Yeah, the whole summer. That would be great. And that's maybe even a conversation to have with the teacher to see what the school policy is.

Dr. Ellen Rome: The policy. Correct.

Nada Youssef: Should they even have their phone out in the middle of the classroom? My kids are too young to even think about that.

Dr. Ellen Rome: But we have kids eight, nine, ten who already have phones.

Nada Youssef: Absolutely. Terrifying. So what about the parents that end up more nervous or worried than their kids, because I know many people that are just really anxious as they are adults, and can reflect on their kids.

Dr. Ellen Rome: When you have a really stressed or anxious parent, have them work on their own stress management strategies so that they can role model some coping skills, and take pride in their child's growth and development. For instance, when we think about a child learning to walk, here's the parent beckoning and the kid, in proving they can step by themselves, in the exact moment when they're trying to reach for their parent, they're proving that they don't need to. So in the same way, we can have the child take those steps into the classroom with joy and delight, and have the parent take pride in those kinds of first steps.

Nada Youssef: Absolutely. And they're independence.

Dr. Ellen Rome: Yes.

Nada Youssef: That's huge. Let's see. So children starting a new school can feel a sense of loss leaving their family environment behind. What do you recommend we say to make them feel at ease? And verbatim if you could.

Dr. Ellen Rome: It's fair game to go back and visit a favorite teacher. Give her a hug, have her say, "I'm so proud of you for graduating my class, and being ready for the second grade," or whatever it is. That's easier if it's the same class or school. If it's not, if the kid's in a whole new building or has moved, that's harder and you can help them find a buddy who's going to be at that school and socialize beforehand. You can devise other strategies.

Dr. Ellen Rome: I had the privilege of going to an awesome all-girls camp outside of Burlington, Vermont and my daughter got to go to the same camp, and it's over a four week or eight week camp, so you go and you're gone. I didn't go until age 13, she went at 12. I wish I could still go back. But one of the things that they did beautifully, was there were campers and camper cabins. Junior counselors live in JC cabins, and counselors live in counselor cabins. So if they had a kid in distress, they would have the JC and the counselor manage the bunkies up, the camp mates, to say hey, how about if you ask so and so to go swimming with you today?

Dr. Ellen Rome: In the same way, you can figure out who are some potential safe kids in that classroom, and often the teacher will know, and you can say, who would be a great kid who would be a positive for this kid? And start arranging parent and kid play dates before school or in the first weeks of school so that kid becomes empowered to have a buddy.

Nada Youssef: Yeah, absolutely. And again, I would say ask the school.

Dr. Ellen Rome: Right.

Nada Youssef: Because currently my kids go to a school where they have a mentorship program where the eighth graders get to couple up with the first graders, second graders, kindergarten and it helps a lot.

Dr. Ellen Rome: Brilliant. And if that's not at your school, suggest it to the school so it can be a thing that can happen.

Nada Youssef: Absolutely. That's a great idea.

Dr. Ellen Rome: And on the buddy theme, you had asked about parents that are anxious. If you really have a super anxious parent, as they launch their kid have the parent find a buddy. Go for a walk, get coffee, whatever they need to do so that they also can socialize and have stress diminish.

Nada Youssef: And talking about things in common, having their kids going to the same school and everything like that.

Dr. Ellen Rome: Yes.

Nada Youssef: So what do we do if we notice changes in our child's behavior lasting beyond just the first couple weeks that you think it's just the first school jitters.

Dr. Ellen Rome: That's worth contacting your pediatrician as well as the teacher. And you may need a counselor or a therapist to help them overcome anxiety, depression, whatever is going on. And help tease out issues. For instance, is that child being bullied, which is often invisible to the teacher. And kids know how to do it very, very, very subtly. We also can tease out other stressors. Or change at home, for instance if there's parental conflict or a divorce happening, or a new step parent.

Dr. Ellen Rome: These are stressors or changes that not every kid is going to be equipped to handle as gracefully as another kid, so that team - parent, ideally parents, teacher, pediatrician, and therapist potentially. And if there's serious anxiety or major depression, it may be even worthwhile to be thinking about medicine, which are not a fix-all but a supplement to what we're doing. And if a child says, "I'm going to kill you," or "I'm going to kill myself," they need to know that their words matter, and so we want to make sure that they learn language that's appropriate to meet their emotional needs that isn't harmful to themselves or other people.

Nada Youssef: Sure. Sure. Now, let's talk about the symptoms of anxiety and depression. I know you mentioned a conflict between parents is like withdrawal, just any change in behavior that's different.

Dr. Ellen Rome: Not wanting to go to school, not wanting to come home from school, new sleeplessness, too much sleep.

Nada Youssef: Eating habits?

Dr. Ellen Rome: Eating habits that change, other fearfulness or anxiety or tears or sadness. It's worthwhile really probing and figuring out where is this kid coming from? And bullying doesn't have to be happening at school. It can be happening in the neighborhood. It can be happening at home. You want to make sure that kid feels safe in all environments.

Nada Youssef: Now, speaking of bullying. If my kid is bullied in school, first of all I want to know what is my first step, but even before we get there how do I know it's not just ... I don't know if that sounds too harsh, but if my kids are being too sensitive, it's her friends may be a lot more aggressive versus there's really, there's a bully at home or a bully in school that I need to go see the teacher about. How can I tell the difference as a parent?

Dr. Ellen Rome: That's a great question. One, whatever is the scenario, you want to validate the kid's feelings. So reflecting that. What I'm hearing you saying is ... that you're feeling blah, blah, blah, blah, blah so the kid feels, oh, Mom or Dad's got this. They hear me. So hearing what they're saying and reflecting back. Two, just as in the workplace, you can look into tell me more, tell me more of your story so that you can have a sense of the facts. It's also worthwhile paying attention to their language and challenging automatic beliefs. This always happens. This never happens. If they're speaking in absolutes, challenge that. Hmm, can you think of a situation where it didn't happen? Can you imagine, what does it look like if ... this would work out really well for you.

Dr. Ellen Rome: So envisioning the positive and then helping them break it down to, okay, you got all the way to school and nobody tossed your backpack on the ground. Or whatever it is. Help them envision what that can look like, and how would they get there? For each kid, you want to empower them to partner with caring adults. And ideally, not just the parent, but also say to the adults outside the home, such as a teacher or a beloved coach if they're in a sport, or an art person. It doesn't have to be the main teacher. It can be one of the other people within the school as well.

Dr. Ellen Rome: You want to evaluate the severity of the mechanism of bullying. What does that look like for this kid? When it exists, it's worth partnering with the school as early as you hear it, and saying here's what I'm seeing and hearing. Here's my kid's reaction. Whether it's perceived or whether it's real, I'd love to partner with you because this kid's perception is his or her reality.

Nada Youssef: Sure. And it' funny, so actually when I was speaking to my seven year old daughter last year, I would start asking kind of more detailed questions than I would, so you said your friend didn't want to play with you. Does she ... I didn't realize that at first grade they're already talking about bullying. That my daughter was already aware of what bullying was. I didn't think she would be. But maybe asking more detailed questions that I should have started a long time ago. Well, I'm getting a lot of live questions, so I'm going to start if that's okay with you.

Dr. Ellen Rome: Well, great. Let's go. Yes.

Nada Youssef: All right. So I have Diane. "My daughter's in pre-K and recently she's totally lost confidence at school. We think she may be getting bullied but can't figure out what's going on. We've talked to the teachers but they haven't seen anything. It seems like a few other kids are having some more issues. What could be going on and how can we help her?"

Dr. Ellen Rome: Her perception is that, if you've got a kid whose lost confidence, it's worthwhile figuring out how do we help her have some wins? How do we have her feel like she can be a success in whatever preschool or pre-K success looks like. So first, I would say to the teacher, I have a kid who's lost her confidence. Can we have her do something where she gets to find some confidence and have a win, in something that perhaps would help her partner with another kid, so that together they end up better.

Dr. Ellen Rome: And it's basically, if you're looking for a book to read, the book Mindset, by Carole Dwek, is one of those things. And to give you this book in a nutshell, they gave little kids ... I can't remember if it was first or second graders, a series of puzzles, and they did a puzzle that was at their grade level, and then a puzzle that was two grade levels ahead, and then a puzzle at their grade level. So each kid got three puzzles. And they did a group of controls, and a group where they were tutoring growth mind-

Dr. Ellen Rome: In a group where they were triggering growth-mindset. The controls, they would praise the kid on their end result. "You did great on that test. Well done." The growth-mindset kids, they would praise the kids on the effort to get there. So, "I am so proud of you for how hard you worked at that." And you can apply that to going to school. What they found in this study was that the kids who were in fixed-mindset, who just got praised on the end result, "Wow, you got an A on that test, well done," instead of, "I am so proud, that was such great effort you put on that," this group, actually, the fixed group, did okay on the first test, and then struggled on the high-level one because they were afraid of failing, and then did even worse on the same original grade-level test. Whereas the growth-mindset kids did same level on the first test, worked even harder and did even better than expected on the challenge test, and then did better than their first round on their last test because they were excited to do the effort as opposed to afraid of failing.

Dr. Ellen Rome: So, helping a kid figure out how just their effort is gonna be a positive and valued can be a next step.

Nada Youssef: That's great. So it's about the journey, not the destination.

Dr. Ellen Rome: Exactly.

Nada Youssef: Exactly the mindset that you're talking about.

Dr. Ellen Rome: It's a great mindset. So, with your pre-K daughter, it may be worthwhile ... doing as much homework from other parents who are having similar issues with their kids, and maybe even helping devise something, a play date, something, a project where the kids get to work together pre-K style to get some success and partner with the teacher on that kind of an effort.

Nada Youssef: Great, thank you. Going on to Kevin, "I work with kids in juvenile court who often move and change schools. Can you discuss what those sorts of changes can do? I'm not referring to problems with staying current with academic assignments, but interested in terms of undermining the ability to form friendships and trusting relationships with teachers and administrators."

Dr. Ellen Rome: Kevin, this kind of situation breaks my heart because it's not about positive youth development, and so there's so many things we can be doing better towards empowering kids. One of them, one of my patients in this situation in changing schools said, "I don't have friends, I have associates. I associate with them at school." But she's learned not to trust, and that was protective for her, but a sad state of how her life works. So, for these kind of kids who are changing schools, especially the ones who have been in juvenile court or detention, it's worthwhile figuring out who do they have in their life when things happen that's cheering them on at the sidelines? And if the kid has nobody they can identify, figure out a way to get a caring adult involved. So, that's number one.

Dr. Ellen Rome: Number two, figure out if you can help them partner with a teacher to get them some role where they're rewarded for the effort. And that may be as simple as praise for not carrying their weapon to school, or managing to get to school despite home bedlam or whatever else is going on. So, just showing up still counts and having somebody notice so that that kid is not invisible is really useful. Engaging them in volunteer activities or religious groups, or anything that feeds the soul and generates a sense of positive self, is a great idea.

Nada Youssef: I like that. Make sure that somebody notices, because a lot of kids don't feel noticed, and just like you said about social media and anything like that. So, I'm gonna try to go through these so I can try to get as many as I can in here.

Dr. Ellen Rome: Go for it.

Nada Youssef: I have Nora, "Can you share some good tips to deal with school and homework with a very anxious child? He gets overwhelmed easily and gets upset, then shuts down."

Dr. Ellen Rome: So, Nora, make sure we're getting snacks in it appropriately so that you don't have a 'hungry' child, that's hungry and angry at the same time. So, that'll be key. Two, help him break it down so that things are in bite-sized pieces so that the homework ends up being not overwhelming, either. So, that may mean "Hey, when we get home, we have a quick break and we run around for 15 minutes, then we get to get this done. Then you can have another quick break, and then we're gonna get this done." And knowing your kid's energy can also help. So, if you know your kid does better if he gets it all done in an hour and then really plays, that's fair game. If you've got a kid who's a procrastinator, saying "Hey, before we do this fun thing, we're gonna just get this little bit done first." So, learning your child's rhythms and rewarding the effort, the progress, and not just the end result should be a way to kind of keep them moving forward.

Dr. Ellen Rome: If the anxiety is overwhelming, partner with the teachers, partner with the parent, partner with a pediatrician, maybe even partner with a therapist to help that kid overcome that anxiety.

Nada Youssef: Great. And then Heidi, "How do I teach my child to stand up for themselves if they get picked on without them saying or doing anything inappropriate or becoming a bully themselves?" That's a very good question, 'cause I always wonder the same. Do I stand up for myself? Do I just run to the teacher? What do you tell your child?

Dr. Ellen Rome: So, 'Do as I say, not as I do,' doesn't tend to work. So, role model at home how to find a positive. And then with a kid, if they're being bullied, it's fair game to help them disconnect from the situation, get out of it as best they can, and learn how to have it be water off their back, or as things that don't get under their skin whenever they can as well. So, 'sticks and stones may break my bones, but words will never hurt me' is really hard to live for a lot of those kids. When they come home at dinnertime and say "So-and-so was picking on me, here's what they said," it's fair game to flip it and say, "What do you think is going on with that kid that they feel so bad about themselves that they're trying to bring you down to their level?" So you can immunize them against the bullying a little bit.

Dr. Ellen Rome: You can also try, again, figuring out is it something physical? Is it words? If it's words, is it online, is it not? If it's online, get them offline. If it's in the present, figure out what's the content of what that bully is saying, and how do you help your kid spin it so whenever that kid says, "You're such a fatty," that kid could translate it to, "Wow, I, the bully, think I'm fat." Or, "You're such a blah-blah-blah," what's a tease that you've heard that bothered your child?

Nada Youssef: Well, with her, it's very simple. "I don't want to play with you today, I have my other friend that I'm gonna play with." And she feels less. You know, something like that.

Dr. Ellen Rome: That's a great one. So, if it's about being excluded, you can have the kid say, "It's not forever. That they were busy that moment, that doesn't mean they're gonna be busy every moment." And then when you see that kid busy, even if you really wanted to play with them, look around. Who else isn't busy? Who else might need a friend that moment that you can be the upstander for?

Nada Youssef: Absolutely. And that's actually exactly what I responded to my child, and it was a very weird first time ever to go through anything like that, and all I said to her was, "Sometimes, it's okay to play by yourself. I play by myself all the time, it's absolutely fine," and explaining to her that if she feels negative in a situation or someone's not making her feel good, just remove yourself from the situation in the safest way possible.

Dr. Ellen Rome: And what we know is that having a buddy at school is very, very protective, but being too popular actually can be a stressor. So, having the kid figure out, "How do I enjoy my one friend, but if they're busy, how do I look elsewhere or play by myself?" And making that okay is important.

Nada Youssef: Great. Well, I have time for one more question from Mike. "If my child tells me they're being bullied at school and they've told the teacher, the bully has been talked to, but the behavior and bullying hasn't changed, should I talk to the bully's parents or request a meeting with the teacher, bully's parents, and me?"

Dr. Ellen Rome: That's a great question.

Nada Youssef: Yeah, that's a good one.

Dr. Ellen Rome: And Mike, there's not one right answer on that. So, I would for sure be talking to the teacher. In a perfect world, it's worthwhile talking to the parent. In practical experience, I've had a lot of families where that's backfired.

Nada Youssef: Yeah, I can see them being defensive.

Dr. Ellen Rome: So, I would get a little bit of a litmus test from the teacher as to whether that's a doable thing or not. And 'requesting a meeting with the teacher, the bully's parents, and me', that could be a really interesting solution but, again, it doesn't always work so well. So, in the case of a kid threatening somebody physically, yes, by all means, that's worthwhile making sure that everyone is on board and hears this. If it's about my kid's feeling bullied enough that they're at risk for self-harm, then it may be worthwhile helping empower and immunize that kid, partnering with a therapist, maybe bringing a psychiatrist, definitely talking to the pediatrician, definitely talking to the school so a kid in crisis doesn't end up a lethal moment as well. So, take your kid's words seriously. If they say, "I wish I were dead," or "I'm going to kill myself," that's an immediate intervention as well.

Nada Youssef: I will use this time to also talk about the National Suicide Prevention Lifeline, just in case that does come up. And that's 1-800-273-TALK, that's 1-800-273-8255, 'cause you can't take that as a joke.

Dr. Ellen Rome: Exactly. And if anyone says, "I'm going to kill so-and-so," that's worth immediate action so that the kid learns their words matter and so that no harm is done so we do not need any further Ohio, or any other state, schoolyard shootings.

Nada Youssef: Sure. Sure thing. Thank you. Well, that's all the time that we have for today, and you've given me some great tips that I'm definitely gonna use on my own kids, but is there anything else you wanted to leave our viewers with, or did we touch on already?

Dr. Ellen Rome: We touched on a lot, yeah. There were two other people who had questions. Do you wanna ...

Nada Youssef: Yeah, we can do ... you wanna run through 'em real fast?

Dr. Ellen Rome: We'll do really fast, 'cause I feel bad for Jennifer and Sarah if we missed 'em.

Nada Youssef: That's okay. So Jennifer, "My son is 12 and gets teased about being overweight, how can I help him? He doesn't wanna go to school and I have a hard time motivating him to exercise or eat well."

Dr. Ellen Rome: So, the kid who's being teased for overweight, it's worthwhile partnering with your pediatrician. And there's many programs, for instance, at the Cleveland Clinic, we have Be Well, we have our Fit Youth programs, we have many great programs that can help the parent and the kid learn the proper lifestyle skills and tools to last them a lifetime. And the good news is, if it's a little kid, time's on their side. If we can get them doing the right life work and go this way, we can also help use that moment for parents to take a look at the family lifestyle. And instead of doing popcorn and a movie, can we do family bowling? Can we go for a walk when it's beautiful out?

Nada Youssef: Hiking, yeah.

Dr. Ellen Rome: Go for the family hike. We've got the whole Emerald Necklace in Cleveland of beautiful hiking areas that, again, Nature Deficit Disorder is another thing parents can actively help with. So, getting that kid an intervention and then also figuring out ways that the can feel valued and visible in a positive way within the school, within the community, can help that kid feel better about themselves.

Nada Youssef: Great, alright. Sarah, "In new situations, I've noticed my son with withdraw and even be rude to kids and adults. I know he's anxious and doesn't know how to manage it. By the time he gets comfortable and starts to have a good time, it's time to leave. How can I help him adjust more quickly in situations like this?"

Dr. Ellen Rome: So, Sarah, it sounds like your kid has a challenge with transitions. So, it may be worthwhile helping him anticipate the transition and figure out, "Alright, when I get to this situation, here are things that help me relax and enjoy it earlier, here are things that are harder for me," and practice those. So, for instance, that may mean doing once-a-week church or something else, or a religious thing, maybe once a week volunteer stuff where parent and child get to volunteer and practice something. So, you can create all sorts of opportunities for a kid to practice those exact skills and have reward happen, again, for the effort. So, practice, mastery, praise for the effort, and good luck with that. May your child succeed in all those new situations this year?

Nada Youssef:   Thank you so much. And to make an appointment with Dr. Rome or any of our pediatricians, please call 216-444-KIDS, that's 216-444-5437, and to stay up-to-date with Cleveland Clinic health news and information, make sure to follow us on Twitter, Facebook, Instagram, and Snapchat @clevelandclinic, one word. Thank you, we'll see you again next time.